City of Topeka | Volunteer Program

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Paige Ashley, Coordinator 320 S Kansas - Map Topeka, KS 66603 785-368-9016 Tel	Police Department Contacts

(V.I.P's) Application
Please fill out completely or the application will not be processed. If any section does not apply to you, please indicate by writing “N/A”. The Topeka Police Department appreciates your interest in service and commends your spirit to volunteer.

Personal Information

Maiden Name, Former Married Name or Alias

Previous Address (if less than 5 years):

Phone: (no hyphens)

Email Address:

Social Security #

Date Of Birth:

Race: (for background check identification only):

What state were you born in?

Which volunteer position are they looking for?

Availability

Indicate the times of day you are available to volunteer
Morning Afternoon Evening All Day

Indicate the days of week you are available

Mon Tue Wed Thurs Fri Sat Sun

Tell us a little about you

Criminal history and driving record

KS Drivers License #

Has your license ever been suspended or revoked?

Have you ever been convicted of a crime?

Education Background

Grade or Degree Completed:

Military service:

References
Do not use family members as references. List four (4) individuals you have known for at least 5 years. (Please list name, complete address with zip code, and telephone number).

Employment History

Current Employer:

Phone number & Contact Person:

Position:

Dates of employment:

Reason for leaving:

Volunteer History

Employer:

Phone number & Contact Person:

Position:

Dates of employment:

Reason for leaving:

Please read carefully and submit
The facts set forth above in my application are true and complete to the best of my knowledge. I understand that if accepted as a Topeka Police Department Volunteer, false statements on this application shall be considered sufficient cause for dismissal. I further understand that an incomplete application or an absence of my signature on this application is just cause for rejection of this application.

My signature authorizes the Topeka Police Department to review my employment records from the employers listed below, also my driving, and criminal records or other background data as it may relate to the position of Topeka Police Department Volunteer for which I am applying. I also authorize the employers listed to release my employment record information to the Topeka Police Department.

(this will substitute for your written signature)

Last Updated: Thursday January 03 2008

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